In June 2017 the Colorado Hospital Association (CHA) quietly launched the Colorado Opioid Safety Pilot, a six-month program aimed at reducing the amount of opioids hospitals prescribe to patients. …
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News of opioid abuse and overdoses has swept the nation in recent years. In Oct. 2017 the Trump administration declared it a national Public Health Emergency under federal law, and the Centennial state is no stranger to the crisis. According to the Colorado Department of Healthcare Policy and Financing, someone in the state died from an opioid overdose every 36 hours in 2016. That same year Colorado saw a 23 percent increase in heroin overdose deaths.
In June 2017 the Colorado Hospital Association (CHA) quietly launched the Colorado Opioid Safety Pilot, a six-month program aimed at reducing the amount of opioids hospitals prescribe to patients. Ten Emergency Departments across the state participated in the pilot, including free-standing emergency rooms, Level 1 emergency departments, and those in rural areas to make sure it worked in all different types of ED’s.
“And it did,” said Cara Welch, communications director for CHA. In just those six months, participating facilities decreased the number of opioids prescribed to patients on average by 36 percent, more than double CHA’s goal, and increased alternatives by 31 percent.
“So, a significant change in a fairly short time. A six-month pilot in health care is very short, but a real change for all of those sites,” continued Welch.
Many hospitals it seems had already been experimenting with giving patients opioid alternatives, but there was no cohesion. CHA is bringing that to the state of Colorado by way of the Colorado chapter of the American College of Emergency Physicians, or CO-ACEP. The association put together specific order sets that could be made available for certain ailments often treated with opioids and CHA is getting the word out.
Opioids act as a sort of blanket treatment, shutting off all of the body’s pain sensors, as opposed to treating the problem, explained Welch. The opioid alternatives are meant to target the pain based on its cause and location. CO-ACEP identified pain pathways such as lower back pain, bone fractured, kidney stones, headaches and migraines and then laid out three or four alternatives physicians could try.
Some of these alternatives are fairly simple, such as using Tylenol and ibuprofen, or trigger point injections. A trigger point injection, Welch explained, could be injecting non-opioid medicine into the back of the head to help with a migraine and headache.
Other CHA-suggested alternatives include using Ketamine, often used for sedation, used in smaller doses to alleviate pain. Lidocaine can be used intravenously as well as topically for pain relief.
Why is it then that the medical community took so quickly and steadfastly to opioids when alternatives were already available?
It became a “knee-jerk reaction,” and using them became “almost habitual,” said Dr. Scott Miner, the medical director of Lutheran Medical Center’s ED in Wheat Ridge.
After CHA’s initial success with the 2017 pilot program, they launched Colorado ALTO (alternatives to opioids) in Jan. 2018 and began working with hospitals and medical systems like SCL Health, which owns Lutheran, to train medical staff on opioid alternatives.
Lutheran was one of those facilities that had already been exploring alternatives, but it wasn’t until January of this year when the hospital started working with CHA that staff got organized in how they administer opioid alternatives as well as measure the outcome, according to Miner.
“So really what we’re trying to do is be fully dedicated to treating pain with all the tools we have available to us, but really trying to be purposeful about only using opiates when absolutely necessary and focusing on alternatives which are often times equally efficacious and safer at the same time,” said Miner. “It’s really trying to address the opioid epidemic through the way that we practice to provide pain relief but also protect our patients from addiction.”
At a hospital with an emergency room that sees about 190 patients a day, around 70,000 a year, Lutheran is already seeing returns. Lutheran’s director of emergency services, Bill Needham said they’ve seen a drop in opioids prescribed in the past six to nine months with just the work of physicians.
While opioids can be an effective pain reducer, Needham said they come with so much “collateral damage” like addiction and the pain of those close to the patient.
In January the nurses, who administer medications prescribed by a physician, went through training with CHA to understand not just how to administer pain alternatives and understand their side effects, but also to be able to educate patients on the change in process as well, said Needham.
Miner said some of his patients have even shown appreciation at being given alternatives because they are aware of the potential harm of opioids.
Before it’s too late
Asked about what she thinks about being prescribed Tylenol for pain, Stacy Pettersen, a former heroin addict who got started on with opioids 30 years ago, is honest.
“Those of us that have been full blow addicts would laugh at that... It’s something altogether different than what they’re seeking,” she said.
Pettersen was prescribed opioids for pain after she slipped on a skateboard and landed on her back at 35 years old. She worked the medical system for years, to maintain a continuous supply but eventually switched to buying heroin from her neighbor when she was about 50. She had countless overdoses during the 12 years she used.
Now 65, she’s been sober for nearly two years and her story made headlines as the opioid conversation ramped up. Her daughter, Brittany, is a Colorado state senator representing Jefferson County and advocates for better opioid and addiction policy.
Pettersen was unaware of Colorado ALTO and said over-the-counter pain medication may be good for those who haven’t been introduced to opioids, even if those in the throes of addiction would find it laughable.
“For the person who’s already been an addict, I’ve never heard of any alternative,” Pettersen said.
However, Colorado ALTO largely wants to prevent patients from being exposed to opioids in the first place. Welch explained that they initially targeted the program at emergency departments because it’s often the first place people are introduced to opioids for pain.
Welch said they will be working with other specialists to implement the system through other hospital departments.
Often pain won’t completely subside with or without opioids, but there are safer options to lessen it. While not an overnight fix, Needham is optimistic about the future
“We are excited to see where this takes us over the next couple of years,” he said.
“If we start to see a drop in narcotic overdoses and things of that nature over time, then certainly that will be beneficial.”
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